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Pelican Community Park

Summer Camps 2014

18115 North Bay Road Sunny Isles Beach, FL 33160

THIS FORM CAN BE COPIED — ONE PARTICIPANT PER FORM. PLEASE PRINT AND FILL OUT COMPLETELY. Participant: First

Last

305.792.1706 (phone) 305.792.1566 (fax)

Date of Birth Non-Resident 

Resident  1

Does this person require assistance or special accommodation to participate in the chosen activity?  Yes  Yes special needs: Specify

M

T-shirt size YS YM YL

F

Grade Entering in Fall 2014:

Street Address Home Phone

Gender  No

Apt# Work Phone

City, State

AS Zip

Cell phone

Email address

Parent/Guardian (if participant is a minor): First

Last

Relationship to Participant

Home Phone

Cell Phone

Email Address

Work Phone

Emergency Contact: First

Last

Home Phone

Cell Phone

Who has child custody:  Check One

Work Phone

 Both  Mother *  Father *

AM

AL

Birth Cert.  Yes

Relationship to Participant Email Address

 Other *(explain)

________________________________

*Must provide legal documentation if a parent has restricted parental rights.

Please  appropriate enrollment: **PLEASE NOTE THAT BEFORE CARE AND AFTER CARE ARE AVAILABLE FOR ALL CAMPS EXCEPT CAMP TOT-LOT!!!

Camps Tot-Lot SIB SIB SIB SIB

Wk1 Jun 9 – 13

Wk2 Jun 16 – 20

Wk3 Jun 23 – 27

Wk4 Jun 30 – Jul 3

Wk5 Jul 7– 11

Wk6 Jul 14 – 18

Wk7 Jul 21 – 25

Wk8 Jul 28– Aug 1

Wk9 Aug 4 – 8

Wk10 Aug 11 – 15

(3-4)

Fresh (5-8) Soph. (9-10) Juniors (11-12) Seniors (13-15)

Before Care (8:00-9:00) After Care (5:00-6:00)

Ages 6-10

Jr Lifeguard

Ages 11-16

Ages 9-16 (Elite*)

Before Care (8:30-9:30) After Care (3:30-4:30)

Specialty Camps Specialty Camps

Fine Arts (Ages 8-14)

Musical Theatre

Musical Theatre

(Ages 7-14)

(Ages 7-14)

Fine Arts (Ages 8-14)

Movie Makers

Musical Theatre

Musical Theatre

(Ages 6-13)

(Ages 7-14)

(Ages 7-14)

Lego (Ages 6-13)

Lego (6-13)

Before Care (8:00-9:00) After Care (5:00-6:00) Cheerlea ding (Ages

Sports (Outdoor)

Baseball (Ages 9-12),

6-12)

SoccerBoys (Ages

Challenger Soccer (Ages

Wacky Sports Week (Ages

SoccerCoed (Ages

Cheerleadi ng (Ages 6-

SoccerCoed (Ages

6-12)

12

6-12)

Olympics

(Ages 11-14)

(Ages 6-12)

Flag Football

6-12)

6-12)

3-14)

(Ages 6-12

SoccerGirls (Ages

Tee ball

Challenger Soccer (Ages 314)

(Ages 6-8),

6-12)

(Indoor)

Soccer Elite

Basketball

Volleyball,

(Ages 6-12)

(Ages 8-14)

SoccerFutsal (Ages

Basketball Elite (Ages

Basketball Elite (Ages

6-12)

7-10)

9-14)

Before Care(8-9:00) After Care (5:00-6:00)

*Registration for Elite Squad of Junior Lifeguard Camp only after swim test on 4/12/14 or 5/10/14!


Summer Camps 2014

Pelican Community Park 18115 North Bay Road Sunny Isles Beach, FL 33160

Rules, Policy and Procedure

305.792.1706 (phone) 305.792.1566 (fax)

Registration A registration form, a copy of child’s birth certificate, a non-refundable registration fee, and a 50% deposit of camp fees are required for camp enrollment. Balance of camp fees is due May 31st (final 50%). If final payment is not received by due date, your reservation will be lost and your deposit WILL NOT be refunded. Cancellations/Changes Camp fees can be refunded (partially*) ONLY IF you cancel your reservation (in writing) with at least 14 days notice to the Cultural & Community Services (CCS) office. *There will be a cancellation fee deducted of $20 per week for any cancellations or transfers. Camp Hours – LATE PICK UP FEES Please take careful note of camp hours for those camps your child is enrolled. For all camps (except Camp Tot-Lot), Before Care is available for an additional fee and this typically starts at 8:00am (8:30am for Junior Lifeguard Camp). For all camps (except Camp Tot-Lot), After Care is available for an additional fee, and this typically runs until 6:00pm (4:30pm for Junior Lifeguard Camp). If you drop off your child earlier than the program start time, you will be charged for Before Care for the week, and you MUST pay this at the time you drop off your child. If you do not pick up your child by the program end time, you will be charged for After Care for the week, and you MUST pay this at the time you pick up your child. Late fees at the completion of aftercare are as follows: • • •

First 15 minutes - $10.00 16 minutes – 30 minutes late: $20 More than 30 minutes late: $20 + $1/minute for every minute thereafter

Please understand that we must pay our employees to stay late with your child until such time that they are picked up, and therefore, we need to cover the cost of their salary for this responsibility. Returned Checks Any returned checks must be settled at the office with cash or money order and will be assessed a $30.00 “returned check” fee. This must be settled immediately, or may result in your child’s removal from the program. Drop off & Pick up Because parking is limited at Pelican Community Park, and as a convenience to parents, we will continue to provide curbside drop off and pick up, in order to provide the quickest and most efficient method for you to drop off and pick up your child. Between the hours of 8:45a.m.—9:15a.m. in the morning, and 4:15p.m.-5:00p.m. in the afternoon, there will be city staff stationed on the sidewalk on North Bay Road, (north side of the school) and also on 181st Drive, waiting for parents to pull up, and will process sign in/out at curbside. For drop off, campers will be taken, by a staff member, to the office for check in. For pick up, campers will be brought out to the car. Campers will be escorted at all times, by a staff member, until they are safely seated in their parents’ vehicle. ANY PERSON PICKING UP A CAMPER WILL ALWAYS BE REQUIRED TO SHOW PICTURE IDENTIFICATION. Campers will ONLY be released to persons listed on the child’s registration form for pick up.

I acknowledge that I have read and understood the above policies and procedures in its entirety and agree to abide by them. Parent Name: _____________________________ Parent Signature: __________________________ Date: __________

sc2014-registrationform  
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